Patterns Of Medication Use Research Articles

749 Medication Use and Comorbidities Among Elderly as Compared to Younger Patients With Inflammatory Bowel Disease in the TARGET-IBD Cohort

INTRODUCTION: As compared to younger patients, much less is known regarding inflammatory bowel disease (IBD)-related medications in elderly (>65 years) patients. This analysis uses a large cohort of patients with IBD to describe the distribution of patient characteristics and patterns of medication use. METHODS: TARGET-IBD is a longitudinal cohort of patients with IBD receiving usual care at community and academic practices in the US. Patients with IBD enrolled between July 2017 and May 2019 were included in this analysis. The prevalence of medication use by drug class at the time of enrollment among patients with both ulcerative colitis (UC) and Crohn's disease (CD) was estimated. Age was stratified into the following categories: >30, 30-49, 50-65 and >65 years. Proportions and means of patient characteristics were compared using tests of association. The odds of biologic use at enrollment was modeled as was the 95% CI by patient characteristics using logistics regression. RESULTS: 681 patients with UC and 979 patients with CD were included in the analysis. At enrollment, mesalamine was the most common medication used among patients with CD > 65 years (34%) and among patients with UC across all age categories (58%-77%, Table 1). Use of mesalamine generally increased with advancing age. Patients with CD > 65 years were more than twice as likely to be users of mesalamine at enrollment than patients <30 years (P < 0.0001). Among patients with either disease type, anti-tumor necrosis factor alpha (anti-TNF) use decreased in patients >65 years compared to patients <30 years. Thiopurine use did not vary across age categories. Among patients >65 at enrollment, use of a 5-ASA derivative, anti-TNF, steroid or thiopurine did not differ by established and newly diagnosed patients. There was no association between age, type of IBD, insurance, gender, race or cardiovascular disease and the odds of biologic use in patients >65 years (Figure 1). CONCLUSION: Elderly patients with IBD, whether those with new diagnoses or individuals with longstanding disease make up a substantial portion of the IBD population. Given that elderly patients demonstrate significant differences in medication use patterns compared to younger patients with IBD, studies of efficacy and adverse events specific to this population are warranted.

1061 Gender Differences in Characteristics of Hospitalized Patients With Cirrhosis: A Prospective Multicenter Inpatient Cohort Study

INTRODUCTION: Women with cirrhosis listed for liver transplant have increased waitlist mortality compared with men, but the reasons for this disparity is not well-established. We hypothesized that women with cirrhosis have different comorbidities and reasons for hospitalizations than men - and explored this hypothesis in a large, multi-center cohort of inpatients with cirrhosis. METHODS: Our cohort included patients with cirrhosis hospitalized non-electively, prospectively enrolled at 4 academic medical centers 1/2013-2/2017. Data collected included comorbidities, reasons for admission, cirrhosis complications, medications, hospital course, and outcomes. Readmission and mortality rates were compared between women and men using logistic regression. RESULTS: Of the 674 hospitalized patients with cirrhosis, 256 (38%) were women. Median age was 56 years; 75% were non-Hispanic White. Women were less likely than men to have cirrhosis from alcohol (34% vs 26%, P < 0.001), and more likely to have NASH (22% vs 15%, P < 0.001). Women and men had similar cirrhosis complications, liver-related medications, MELD (20 vs 20, P = 0.36), and Child-Pugh (9 vs 10, P = 0.36) scores. Women were more likely to have certain non-liver related comorbidities, including insulin-dependent diabetes (23% vs 14%, P = 0.002) and connective tissue disease (4% vs 1%, P = 0.004), as well as to require non-opiate pain medications (14% vs 7%, P = 0.008) or antidepressant/sleep aids (38% vs 28%, P = 0.005). Overall infection rates on admission were similar between women and men (27% vs 22%, P = 0.19), but women were more likely than men to have UTIs (14% vs 4%, P < 0.001) and less likely to have SBP (6% vs 11%, P = 0.04). Rates of other decompensating events were similar between women and men, including GI bleeding, renal dysfunction, and volume overload (P for all > 0.05). There were no differences between women and men in 30d (11% vs 13%, P = 0.60) or 90d (22% vs 27%, P = 0.18) mortality. In logistic regression, female gender was not associated with increased 30d mortality (OR 0.88, 95% CI 0.54-1.43, P = 0.60) or 90d readmission (OR 1.06, 95% CI 0.75-1.48, P = 0.76). CONCLUSION: Although women and men hospitalized with cirrhosis have similar severity of liver disease, they differ by their etiologies of cirrhosis, non-liver related comorbidities, infectious complications, and patterns of medication use. Future studies should further explore the role that these non-liver-related factors play in contributing to well-established gender disparities in waitlist outcomes.

Trends in prescriptions and costs of inhaled medications in chronic obstructive pulmonary disease: a 19-year population-based study from Canada.

BackgroundThe patterns of medication use in chronic obstructive pulmonary disease (COPD) may change over time due to the availability of new medications, updates in guideline-based recommendations, and changes in patient and care provider preferences.ObjectivesTo document population-level trends of filled prescriptions and costs for major classes of inhaled COPD therapies.MethodWe used administrative health databases of the province of British Columbia, Canada, from 1997 to 2015, to create a retrospective cohort of COPD patients. We documented the percentage of patients receiving major inhaled COPD-related medications, including short-acting beta-2 adrenoreceptor agonists (SABA), long-acting beta-2 adrenoreceptor agonists (LABA), inhaled corticosteroids (ICS), short-acting muscarinic receptor antagonists (SAMA), and long-acting muscarinic receptor antagonists (LAMA). We quantified the average, and relative annual change in, dispensed quantities and costs (in 2015 Canadian dollars [$]) of medications. Combination therapy was assessed as the proportion of time covered by two or more long-acting medications of different classes.ResultsA total of 176,338 patients were included in the final cohort (mean age at entry 68.7, 48.5% female). In 2015, the most common medication was ICS (45.7% of the patients), followed by LABA (36.5%). LAMA was the least used medication (18.9%). The number of filled prescriptions per patient per year for LAMA (+7.8% per year) and LABA (+4.9%) increased, while they decreased for SAMA (−6.3%) and SABA (−3.8%), and remained relatively constant for ICS. The average annual per-patient costs of inhaled medications were $570.8 in 2015, which was double the costs from 1997. Single-inhaler ICS/LABA had the highest rate of increase (11.6% per year), and comprised 53.7% of the total costs of inhalers in 2015. In 2015, 28.5% of the patient time was on combination therapies, with 7.1% on triple ICS/LABA/LAMA therapy.ConclusionUtilization of inhaled therapies for COPD has changed significantly over time. The low utilization of LAMA and high utilization of combination therapies (particularly those containing ICS) do not seem to be aligned with COPD treatment guidelines.

Prevalence of therapeutic drugs in blood of drivers involved in traffic crashes in the area of Bologna, Italy

IntroductionPsychoactive medicines, such as benzodiazepines and Z-drugs (BdZ), antidepressants and antipsychotics (AA) and medical opioids (MO), have an impairing effect on driving ability. In previous epidemiological studies performed on impaired and/or injured drivers, not all relevant psychoactive substances were included in the toxicological assessment, and their prevalence may be underestimated. This study aims to assess the prevalence of a large set of psychoactive substances (n=53) in Italian drivers involved in a road traffic crash and in predefined population subgroups. Materials and methodsThe toxicological analyses were performed on the whole blood of 1026 drivers involved in a road traffic crash in the area of Bologna, Italy, from January 2017 to March 2018. Analyses were performed using GC-FID (alcohol), GCMS (illicit drugs) and LC/HRMS (psychoactive drugs). The population was divided into subgroups according to gender, age and crash time. Descriptive statistics were used in order to assess differences among sub-groups. ResultsThe highest prevalence was found for alcohol (17.3%), followed by medicinal drugs (13.6%) and illicit drugs (5.5%). The prevalence of BdZ, AA and MO were 7.3%, 7.2% and 3.1%, respectively. The frequency of BDZ and AA was significantly higher in female drivers and showed higher prevalence at increasing age. The presence of medicinal drugs was significantly higher during the week and in crashes occurring during the day. ConclusionResults for alcohol and illicit drugs partially overlap with those reported in previous European and Italian studies, but the prevalence of BdZ was much higher. We also found a high prevalence of AA, which are rarely investigated in epidemiological studies performed on drivers, but may cause impairment of the ability to drive, especially when taken in combination with alcohol or other drugs. The pattern of medication use differs from that involving drugs of abuse, since it is mainly observed in female subjects and older drivers and does not follow the same weekly trend observed for alcohol and other illicit drugs.

Patterns of medication use before, during and after pregnancy in women with systemic lupus erythematosus: a population-based cohort study.

This study aimed to characterize the patterns of medication use before, during and after pregnancy in a population-based cohort of women with systemic lupus erythematosus (SLE). Using population-based administrative data in British Columbia, Canada, with valid information on start date of pregnancy, we identified women with SLE who had singleton pregnancies ending in deliveries between January 1, 2002, and December 31, 2012. We assessed the proportion of SLE pregnancies exposed to SLE medications - namely antimalarials and immunosuppressants - as well as glucocorticosteroids, and nonsteroidal anti-inflammatory drugs (NSAIDs) 24 months before pregnancy, each trimester of pregnancy, and 12 months postpregnancy. We also assessed discontinuation of antimalarials and immunosuppressants, defined as no prescriptions in a given window following a prescription in a preceding window. Of 376 pregnancies (284 women) with SLE, 24.2% had one or more dispensing for antimalarials, 8.2% for azathioprine, 19.7% for glucocorticosteroids and 4.8% for NSAIDs during pregnancy. We observed a 16.7% discontinuation of antimalarials in the year prior to pregnancy, 29.8% in the first trimester, 9.7% in the second trimester, and 26.0% in the third trimester. We also observed a 29.2% discontinuation of azathioprine in the first trimester, 8.0% in the second trimester, and 9.1% in the third trimester. These population-based data show frequent discontinuation of medications, particularly antimalarials, in SLE pregnancies. These findings suggest the importance of educating women with SLE who are pregnant or planning to become pregnant on the benefits and risks of medications during pregnancy.

Patterns of medication use and the burden of polypharmacy in patients with chronic kidney disease: the German Chronic Kidney Disease study.

BackgroundPatients with chronic kidney disease (CKD) bear a substantial burden of comorbidities leading to the prescription of multiple drugs and a risk of polypharmacy. However, data on medication use in this population are scarce.MethodsA total of 5217 adults with an estimated glomerular filtration rate (eGFR) between 30 and 60 mL/min/1.73 m2 or an eGFR ≥60 mL/min/1.73m2 and overt proteinuria (>500 mg/day) were studied. Self-reported data on current medication use were assessed at baseline (2010–12) and after 4 years of follow-up (FU). Prevalence and risk factors associated with polypharmacy (defined as the regular use of five or more drugs per day) as well as initiation or termination of polypharmacy were evaluated using multivariable logistic regression.ResultsThe prevalence of polypharmacy at baseline and FU was almost 80%, ranging from 62% in patients with CKD Stage G1 to 86% in those with CKD Stage G3b. The median number of different medications taken per day was eight (range 0–27). β-blockers, angiotensin-converting enzyme inhibitors and statins were most frequently used. Increasing CKD G stage, age and body mass index, diabetes mellitus, cardiovascular disease and a history of smoking were significantly associated with both the prevalence of polypharmacy and its maintenance during FU. Diabetes mellitus was also significantly associated with the initiation of polypharmacy [odds ratio (OR) 2.46, (95% confidence interval 1.36–4.45); P = 0.003].ConclusionMedication burden in CKD patients is high. Further research appears warranted to address the implications of polypharmacy, risks of drug interactions and strategies for risk reduction in this vulnerable patient population.

Prevalence of medication and off-label medication use in acquired brain injury at a neurorehabilitation hospital.

Patients who suffer acquired brain injury (ABI) require a great variety of drugs. Furthermore, the lack of evidence on the medication effects in this type of patient increases off-label prescription. The aim of this study was to describe the pattern of medication use and the practice of prescribing off-label drugs in these patients. A cross-sectional study was conducted in patients with ABI, of either traumatic or non-traumatic cause, admitted to a neurorehabilitation hospital for rehabilitation. Demographic and clinical data and prevalence of medication use and off-label prescription were collected. The majority of the studied patients (85.2%) were considered polymedicated since they were prescribed ≥ 6 drugs concomitantly. In traumatic brain injury (TBI) patients, antidepressants (81.5%) were the Anatomical Therapeutic Chemical (ATC) group's most prescribed versus antithrombotic agents (80.5%) in non-traumatic brain injury (N-TBI) patients. Up to 37.3% of all active substances prescribed in TBI patients were off-label compared with 24.9% in N-TBI patients. The most prescribed off-label active substances in both groups were those related to the Nervous System (N) ATC group to treat neurobehavioural problems. A multidisciplinary pharmacotherapeutic follow-up of these patients would be essential to address the high prescription rate of medications and the off-label prescription practice. In this way, medication problems related to polypharmacy could be minimised and the benefit-risk ratio of prescribed off-label drugs could be ensured according to the available medical evidence.

Pattern of medication use in geriatric patients at primary health care facilities in Karawang, Indonesia.

BackgroundRational drug use is a critical component in patient care, particularly among the elderly who often have multiple medical problems. The aim of this study was to assess the pattern of medication use among the elderly visiting primary health care facilities.MethodsA retrospective cross-sectional study was conducted at 25 primary health care facilities in Karawang District, Indonesia, and patients aged ≥60 years visiting the facilities from January to December 2014 were included. A systematic random sampling technique was used to select the study samples. Each prescription was assessed using the WHO prescribing indicators.ResultsA total of 10,118 prescriptions with 31,927 drugs were assessed. The average number of drugs prescribed was 3.15 (range: 1–7). Drugs prescribed by generic name comprised 98.09% (n=31,318) of the total number of drugs. Medical appointments wherein an antibiotic was prescribed constituted 23.45% (n=2373) of the total number of prescriptions. No injections were prescribed in this study setting. Drugs prescribed from the essential drug list comprised 83.07% (n=26,522). Paracetamol (13.44%), vitamin B complex (8.05%), and aluminum–magnesium hydroxide (7%) were the most frequently prescribed drugs, whereas amoxicillin (44.03%), chloramphenicol (13.10%), and ciprofloxacin (12.00%) were the most frequently prescribed antibiotics.ConclusionOur findings highlight that polypharmacy and prescription of essential drugs remain subjects of concern in geriatric health care. Regular medication review and promoting the use of the essential drug list among health care professionals are encouraged in primary care settings.

Pattern of medication use in children with very poorly controlled asthma

Pattern of medication use in children with very poorly controlled asthma

Patterns of medication prescription by dementia diagnosis in Australian nursing home residents: a cross‐sectional study

AbstractBackgroundCurrent information on the patterns of medication use in nursing home residents living with dementia is conflicting.AimThe aim of this study was to investigate medication use and its associations with dementia diagnosis in Australian nursing home residents.MethodsA cross‐sectional study of 541 residents from 17 Australian nursing homes was performed.ResultsOver 12 months, nursing home residents were prescribed a mean (±SD) of 14.5 ± 6.8 medications each. Approximately 95% of residents were prescribed medications for the nervous system, and 94% were prescribed medications for the alimentary tract and metabolism. After adjustment for potential confounders, those with dementia were less likely to be prescribed medications for the cardiovascular system (odds ratio (OR) 0.45, 95% confidence interval (CI) 0.27–0.77, p = 0.0032) and respiratory system (OR 0.38, 95% CI: 0.25–0.60, p < 0.0001). Further analysis of specific medications showed that residents with dementia were more likely to be prescribed risperidone (OR: 9.38, 95% CI: 4.01–21.94, p < 0.0001), buprenorphine (OR 3.37, 95% CI: 1.78–6.36, p = 0.0002) and trimethoprim (OR 1.78, 95% CI: 1.06–2.97, p = 0.0282), but less likely to be prescribed glyceryl trinitrate (OR 0.42, 95% CI: 0.19–0.94, p = 0.0340) and salbutamol (OR 0.34, 95% CI: 0.2–0.6, p = 0.0002) in addition to other specific medications.ConclusionsIncreased awareness of possible undertreatment of cardiovascular and respiratory conditions, and possible overtreatment of urinary tract infection, in those living with dementia in nursing home settings may improve management of this vulnerable population.

Longitudinal study of medication use in caregivers of people with Alzheimer’s disease – Kuopio ALSOVA study

The longitudinal pattern of medication use among family caregivers of people with dementia is not well understood, despite the potential for medication over- or under-use. To investigate caregiver medication use over a five-year follow-up using data obtained via self-report and from a national prescription register, and compare agreement between medication data obtained from the two sources. Medication data for 222 family caregivers of people with Alzheimer's disease were obtained via self-report and from the Finnish Social Insurance Institution. Generalised estimating equations, Kappa statistics and related samples Wilcoxon signed rank test were used to analyse medication use over time. The mean number of medications used by caregivers increased from 3.4 to 4.1 (self-reported current regular medications) and 2.4 to 2.8 (reimbursed prescription medications during the past 90 days) over five years (p < 0.001). Significantly, more medications were identified via self-report (mean 3.6, SD = 3.3) than the national prescription register (mean 2.6, SD = 2.4, Z= -12.300, p < 0.001). Agreement between the two data sources was good for cardiovascular medications and anti-hypertensives (Kappa = 0.883-0.967, p < 0.001) and medications for acid-related disorders (Kappa = 0.508-0.092, p < 0.001). Agreement was moderate for analgesics (Kappa = 0.281-0.477, p < 0.001) and psychotropics (Kappa = 0.281-0.562, p < 0.002). The proportion of caregivers using five or more medications increased from 27.5% to 44.6% (self-report), and 16.7% to 27.7% (register) (p < 0.001). Caregivers use an increasing number of medications in the first five years of caring for persons with dementia, and self-report using a higher number of medications than data from the national prescription register suggest.

Changes in health care utilization during the MERS epidemic

Background: In 2015, MERS epidemic in korea has had a great impact on not only health care but also society as a whole. Fear of new infectious diseases has dampened the daily lives of citizens and limited activities. Above all, citizens have reduced visits to hospitals, which can lead to a situation where patients who need medical care can not use medical service. The purpose of this study is to analyze how medical use of patients with emergent or severe illness has changed during the period of MERS epidemic. Methods & Materials: We used data from the Korea National Health Insurance (KNHI) Claims Database for 2013–2016. In Korea, 97% of the population is obligated to enroll in the KNHI program; the remaining 3% is covered by the Medical Aid Program. We analyzed patterns of medical use during the same period of 2013, 2014, and 2016, compared to the 2015 epidemic. The medical treatment was divided into the change of total use, emergency room, intensive care unit and respiratory infectious diseases. In addition, we analyzed the MERS epidemic area and the non epidemic area. Results: The total number of medical use decreased during the period of the epidemic in June and July, and decreased in both admission and outpatient treatment, but the number of hospital admissions increased rapidly after August, when the epidemic slowed down. Intensive care unit and number of operations did not decrease significantly, but the number of emergency room visits decreased by more than 20% and rose again after August.There were no significant changes in the number of chronic diseases such as diabetes and hypertension, and there was no significant change in acute diseases such as myocardial infarction and stroke. There was a large difference between epidemic and non epidemic areas, with no decrease of more than 5% except for the emergency room. Conclusion: Although the MERS epidemic has affected the whole population, the use of medical care for severely ill patients has not been reduced by preventing the spread through hospital closure and isolation of contacted persons.

Clinical characteristics and medication patterns in patients with COPD prior to initiation of triple therapy with ICS/LAMA/LABA: A retrospective study.

This study assessed patient-level characteristics and patterns of medication use in patients with chronic obstructive pulmonary disease (COPD) before initiation of multiple inhaler triple therapy (MITT; long-acting muscarinic antagonist/long-acting β2-agonist/inhaled corticosteroid [ICS/LAMA/LABA] combination). This retrospective study was conducted using the Optum Research Database. Patients enrolled in commercial or Medicare Advantage Prescription Drug plans, with a COPD diagnosis and >1 prescription for a COPD medication between January 2014 and March 2016 were included. The dispensing date for the first pharmacy prescription completing MITT with at least 1 day of overlap was the patient's index date. The 12 months prior to this date were used to assess patient characteristics, exacerbations, eosinophil counts and changes in medication. The study population comprised 13,701 patients. At the index date, most patients were using a LAMA (n = 13,353 [97.5%]) and combination ICS/LABA (n = 13,292 [97.0%]) MITT. Overall, 90.4% of patients used a LABA, LAMA, LAMA/LABA, or ICS/LABA or had a moderate or severe exacerbation at any time during the baseline period, indicating that approximately 10% of patients initiated MITT without prior bronchodilator use or exacerbation history. Over 65% of patients with an eosinophil measurement had a value ≥ 150 cells/μL. Overall, it appears that in this patient population, ICS/LAMA/LABA as triple therapy is being initiated after use of a bronchodilator and/or after an exacerbation event, in accordance with accepted treatment recommendations.

Real-world health outcomes in adults with moderate-to-severe psoriasis in the United States: a population study using electronic health records to examine patient-perceived treatment effectiveness, medication use, and healthcare resource utilization

BackgroundLittle is known regarding real-world health outcomes data among US psoriasis patients, but electronic health records (EHR) that collect structured data at point-of-care may provide opportunities to investigate real-world health outcomes among psoriasis patients. Our objective was to investigate patient-perceived treatment effectiveness, patterns of medication use (duration, switching, and/or discontinuation), healthcare resource utilization, and medication costs using real-world data from psoriasis patients.MethodsData for adults (≥18-years) with a dermatology provider-given diagnosis of psoriasis from 9/2014–9/2015 were obtained from dermatology practices using a widely used US dermatology-specific EHR containing over 500,000 psoriasis patients. Disease severity was captured by static physician’s global assessment and body surface area. Patient-perceived treatment effectiveness was assessed by a pre-defined question. Treatment switching and duration were documented. Reasons for discontinuations were assessed using pre-defined selections. Healthcare resource utilization was defined by visit frequency and complexity.ResultsFrom 82,621 patients with psoriasis during the study period, patient-perceived treatment effectiveness was investigated in 2200 patients. The proportion of patients reporting “strongly agree” when asked if their treatment was effective was highest for biologics (73%) and those reporting treatment adherence (55%). In 16,000 patients who received oral systemics and 21,087 patients who received biologics, median treatment duration was longer for those who received biologics (160 vs. 113 days, respectively). Treatment switching was less frequent among patients on systemic monotherapies compared to those on combination therapies. The most common reason for discontinuing biologics was loss of efficacy; the most common reason for discontinuing orals was side effects. In 28,754 patients, higher disease severity was associated with increased healthcare resource utilization (increased visit frequency and complexity). When compared between treatment groups (n = 10,454), healthcare resource utilization was highest for phototherapy. Annual medication costs were higher for biologics ($21,977) than oral systemics ($3413).ConclusionsReal-world research using a widely implemented dermatology EHR provided valuable insights on patient perceived treatment effectiveness, patterns of medication usage, healthcare resource utilization, and medication costs for psoriasis patients in the US. This study and others utilizing EHRs for real-world research may assist clinical and payer decisions regarding the management of psoriasis.

Inappropriateness of medication use and associated health risks: A cross-sectional study from Pakistan

Purpose : To evaluate the patterns of medication use and medication appropriateness among people in different regions of Pakistan. Methods : A cross-sectional study involving 410 individuals in four provinces of Pakistan (Punjab, Sindh, Baluchistan and Khyber Pakhtunkhwa) as well as the capital city, Islamabad, via a convenient sampling method. The questionnaire used comprised three major sections: (a) medication use patterns of the population, (b) medication storage and wastage practices, and (c) development of secondary disease after medication use. The questionnaires were completed under the supervision of pharmacists trained for the purpose. Results : The majority of the study population preferred bottle caps for taking oral liquid medicines (83.9 %), and the proportion using bottle caps was highest in Punjab (55.2 %) followed by Sindh (21.8 %). A significant proportion of the population consider the use of very hot water as a reconstitution medium for suspensions (36.3 %). In many cases, suspensions were constituted by mere estimation of the vehicle used (56.1 % from Punjab, 18.9 % from Sindh, 16.1 % from KPK, 7.7 % from Baluchistan, and 1.1 % from Islamabad). Significant differences were observed in the handling of leftover drugs among respondent populations, as well as the overall diverse modes of disposal recorded (43.9 %). Doctors (46.6 %) and relatives were the main sources of instructions on medicine usage (37.6 %). A disinclination to purchase a full course of medicine was observed. Knowledge of medicine storage and measuring tools for oral liquids showed striking peculiarities among the various study populations. Conclusion : Inappropriate medication use among the general population of Pakistan requires educational interventions and awareness programs to promote rational drug use in the society. Keywords : Inappropriate, medication, population, healthcare, use

The Impact of Dementia Diagnosis on Patterns of Potentially Inappropriate Medication Use Among Older Adults.

Use of potentially inappropriate medications (PIM) among people with dementia is common. We assessed the patterns of medication use from 1-year before dementia diagnosis, to 1-year after dementia diagnosis, compared with patterns of medication use in people without dementia. We conducted longitudinal study using the National Alzheimer's Coordinating Center data. Adults aged 65 years and older newly diagnosed with dementia (n = 2,418) during 2005-2015 were year, age, and sex matched 1:1 with controls. Generalized estimating equation models weighted for missingness and adjusted for 15 participant characteristics were fit. Among participants with dementia, number of medications reported 1-year prediagnosis was 8% lower than at diagnosis year (p < .0001) and 11% higher 1-year postdiagnosis compared with year of diagnosis (p < .0001). Among participants with dementia, the odds of PIM exposure, assessed using the 2015 Beers Criteria, was 17% lower 1-year prediagnosis (p < .0001) and 17% higher 1-year postdiagnosis (p = .006) compared with year of diagnosis. Among controls, there were approximately 6% more medications reported between consecutive years (p < .0001 each comparison) and the odds of PIM exposure increased 11% between consecutive years (p = .006 and p = .047). At each annual follow-up, participants with dementia had lower odds of PIM exposure than their controls (prediagnosis p < .0001, at diagnosis p = .0007, postdiagnosis p = .03, respectively). There were no differences in exposure to anticholinergic medications. Number of medications and PIM use increased annually for participants with and without dementia. Persistent challenge of increasing PIM use in this group of older adults is of major concern and warrants interventions to minimize such prescribing.

Patterns of use, knowledge, and perceived effects of sedating medication on driving: A questionnaire survey of Japanese drivers who use sedating medication

ObjectiveThis study was designed to investigate patterns of medication use among drivers using pharmaceutical drugs, the subjective impact of medication use on driving, and knowledge about the effects of medication use on driving. MethodsAn online survey was administered to a sample of Japanese drivers (n = 1424, age range 21–79 years) to investigate the use pattern of major sedating medications such as cold/sinus drugs, anxiolytics, hypnotics, and antidepressants. The strength of association between variables pertaining to the use of sedating medications and self-reported at-fault crash involvement was explored using a series of multivariate logistic regression models. ResultsOn average, respondents reported using 2.7 sedating medications over the past two years (standard deviation = 1.8; range = 0–11). The pattern of psychotropic medication use was diverse, and the use of multiple psychotropic medications was common. Respondents could be grouped into four subgroups in terms of multiple medication use. Irrespective of the type of medication taken, respondents noticed few adverse side effects of medication on driving and generally did not adhere to driving-related product warnings; some respondents were unaware of important facts such as the exacerbation of the effects of medication effects when combining medications. Multivariate logistic regression analyses showed that the presence of a higher number of sedating agents in the medication taken was positively associated with reporting an at-fault crash in the last two years, having longer driving distance, being a commercial driver, receiving more traffic tickets, and having a higher tendency for rules violations. ConclusionsThe present study showed that medication use by drivers is diverse and complex, that most drivers are not sufficiently informed of the potentially impairing effects of medication, and that poly-medication use appeared prevalent among those who use psychotropic medications. In line with previous studies, the current study reveals a need for better communication between health experts and patients and for education of all stakeholders. The results also highlighted the need for systematic investigation into cause of crash in light of potential contribution of sedating medication used by the driver, given the low autopsy rate for fatally injured drivers in Japan.

Assessment of morbidities and pattern of medication use among medical in-patients in a university teaching hospital South-South Nigeria

Aim: The pattern of morbidities in a setting often influences the pattern of medications prescribed. Intensified global efforts to improve the rational use of medications necessitated the development of medication use indicators. Materials and Methods: This was a descriptive, prospective study in which inpatients admitted into the internal medicine wards of a teaching hospital over a 9-month period between December 2015 and August 2016 were evaluated on specific days following admission using the World Health Organization-International Network for the Rational Use of Drugs (WHO-INRUD) prescribing indicators. Results: A total of 507 patients were evaluated; 269 patients (53.1%) were male, 238 patients (46.9%) were females, and their age range was 17–89 years. The most common morbidities among these inpatients were infectious diseases such as Malaria (18.9%) and HIV/AIDS (17.2%). The noninfectious disease conditions, diabetes mellitus (17%), and hypertension (16.8%) were next in prevalence. Most patients (412 patients; 81.3%) had more than one morbidity. The most commonly prescribed medications were 5% glucose in saline (300 patients; 59.2%), Vitamin B complex (257 patients; 50.7%), and furosemide (183 patients; 36.1%). The average number of medications prescribed per patient during admission was 9.1 ± 3.8 drugs, while the median number of medications used during admission was eight drugs. The percentage of medications prescribed by generic names was 85.6%, while 88.1% of medications were prescribed from the essential medicines list. Conclusion: The pattern of medication use was largely in-keeping and consistent with the pattern of morbidities despite confirmatory diagnosis and symptomatic treatment observed in most instances. This translates to rational and safer pharmacotherapy practices as the modified WHO-INRUD prescribing indicator will be a useful monitoring tool for rational medication prescriptions among inpatients.

A community-based cross-sectional study on the use of medication among young children in the rural areas of Assam

Introduction: Management of childhood illness is different from that of adult diseases. Medications during infancy and early childhood should be very cautiously used. Therefore, this study was conducted to determine the different patterns of medication use among the children up to 2 years of age in a rural community. Materials and Methods: This was a community-based cross-sectional study conducted in a rural area of Assam where we randomly selected 380 children below 2 years of age. Results: Among 380 children, 203 reported suffering from any disease in the last 2 months. Total 105 children (51.7%) were treated with allopathic medicines while 66 children (32.5%) were treated with AYUSH medication and 32 (15.8%) were treated with home remedies. Antipyretics were (24%) the most common drug used followed by oral rehydration salt (21.5%) (ORS) and antibiotics (15.5%). Parents of 44 children (21.7%) practiced self-medication. Only in 62.5% of the cases, full compliance to prescribed medicines was seen. Conclusion: High prevalence of traditional therapy, self-medication, and noncompliance among the children in a rural area indicated the role of health education to parents, especially the mothers.

Cultural Issues in Medication Adherence: Disparities and Directions.

Adherence to medications is dependent upon a variety of factors, including individual characteristics of the patient, the patient's family and culture, interactions with healthcare providers, and the healthcare system itself. Because of its association with worse outcomes, poor medication adherence is considered a potential contributor to disparities in health outcomes observed for various conditions across racial and ethnic groups. While there are no simple answers, it is clear that patient, provider, cultural, historical, and healthcare system factors all play a role in patterns of medication use. Here, we provide an overview of the interface between culture and medication adherence for chronic conditions; discuss medication adherence in the context of observed health disparities; provide examples of cultural issues in medication adherence at the individual, family, and healthcare system/provider level; review potential interventions to address cultural issues in medication use; and provide recommendations for future work.